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General NPI Number Information
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NPI Number | 1043529217
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Entity Type | Organization
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Legal Business Name | KIDS UNLIMITED THERAPY FUN AND FITNESS CENTER, P.C.
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 6755 PHELAN BLVD SUITE 38
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City | BEAUMONT
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State | TX
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Zip | 77706-6075
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Country | US
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Telephone | 409-554-4616
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Fax | 409-554-4617
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Provider Business Mailing Address
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Address Line | 6755 PHELAN BLVD SUITE 38
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City | BEAUMONT
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State | TX
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Zip | 77706-6075
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Country | US
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Telephone | 409-554-4616
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Fax | 409-554-4617
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Authorized Official
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Title or Position | DIRECTOR OF PHYSICAL THERAPY
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Name | MRS. HALEY BROOKE TREME
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Credential | P.T.
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Telephone | 409-554-4616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1165229
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License Number State | TX
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